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Modifier NU

New Equipment

Modifier NU identifies new equipment when reported with an applicable HCPCS Level II code. It distinguishes new equipment from rental or used equipment for billing purposes.

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Related Modifiers

Modifier RR

Rental Equipment

Modifier UE

Used Equipment

Modifier KH

Initial DMEPOS Claim

What Is Modifier NU?

Modifier NU is a HCPCS Level II modifier used to identify durable medical equipment (DME) supplied as new equipment.

It is appended to an applicable HCPCS code to distinguish new equipment purchases from equipment rentals or used equipment transactions.

Modifier NU is commonly associated with DMEPOS billing, including certain mobility aids, respiratory equipment, and other medically necessary devices.

Key Billing Considerations:

Equipment Condition: The item must qualify as new equipment.
HCPCS Compatibility: The equipment code must permit or require NU under the applicable payer policy.
Medical Necessity: The equipment must meet relevant coverage and medical necessity requirements.
Purchase Status: NU identifies new equipment; it does not independently establish that an item is covered or payable.

Important: Not every new DME item requires Modifier NU. Requirements depend on the equipment category, HCPCS code, and payer guidelines.

Quick Reference

Modifier: NU

Type: Equipment Condition

Category: DMEPOS

Meaning: New Equipment

Billing: Purchase

Medical Necessity: Required

When to Use Modifier NU

Report Modifier NU when new durable medical equipment is furnished and the applicable payer requires or recognizes NU to identify the equipment's condition.

New Equipment Purchase: The patient receives equipment that has not previously been used, and the claim is billed under an applicable purchase arrangement.

Eligible HCPCS Code: The equipment is reported using a HCPCS code for which NU is appropriate under the payer's billing requirements.

Medical Necessity Established: The patient's condition and supporting documentation satisfy applicable DME coverage criteria.

Required Purchase Documentation: The supplier maintains the necessary order, delivery records, and other documentation supporting the claim.

Payer-Specific Requirements: NU is included when required by Medicare, Medicaid, or a commercial insurer for the particular equipment and billing circumstances.

Important: Modifier NU identifies the equipment as new. It does not replace required medical necessity documentation or other applicable DMEPOS modifiers.

When NOT to Use Modifier NU

Modifier NU should not be reported when the equipment or billing arrangement does not qualify for the new-equipment designation.

Rental Equipment: Do not use NU to identify an equipment rental when Modifier RR or another applicable rental modifier is required.

Used Equipment: Do not report NU for previously used equipment when Modifier UE is appropriate.

Ineligible HCPCS Codes: Avoid appending NU to equipment codes that do not permit or require the modifier under the applicable payer policy.

Supplies and Accessories: Do not automatically apply NU to disposable supplies, replacement accessories, or other items solely because they are new.

Unsupported Equipment Status: Do not report NU when the supplier cannot substantiate that the equipment qualifies as new.

Important: A new item does not automatically require NU. Always verify the HCPCS code and payer-specific modifier requirements.

Modifier NU vs. RR and UE

Modifiers NU, RR, and UE identify whether durable medical equipment (DME) is new, rented, or used. Selecting the correct modifier helps ensure accurate equipment billing.

Modifier NU – New Equipment: Used when new durable medical equipment is purchased and the payer recognizes or requires the modifier.

Modifier RR – Rental: Identifies equipment furnished on a rental basis rather than purchased.

Modifier UE – Used Equipment: Used when previously owned or used equipment is supplied under an applicable billing arrangement.

Key Differences:

NU: New equipment purchased.
RR: Equipment rented.
UE: Previously used equipment.

Important Billing Rule: NU and UE describe equipment condition, while RR identifies a rental arrangement. Modifier requirements depend on the HCPCS code, equipment category, and payer guidelines.

Billing Example

A patient receives a new, medically necessary durable medical equipment item from an enrolled DME supplier. The equipment is purchased rather than rented, and the applicable payer requires Modifier NU.

Example Claim:

HCPCS Code: E0143 – Walker, folding, wheeled, adjustable or fixed height
Modifier: NU – New Equipment
Reported Code: E0143-NU
Billing Arrangement: Purchase of new equipment
Supporting Records: Standard written order, medical necessity documentation, and proof of delivery

Why Modifier NU Applies: The supplier furnished a new walker under a purchase arrangement. NU identifies the equipment as new rather than rented or used.

Important: This is an illustrative billing example. Coverage, payment category, and modifier requirements must be verified for the specific HCPCS code and payer.

Documentation Requirements

Claims submitted with Modifier NU must be supported by records establishing medical necessity, equipment eligibility, and delivery.

Standard Written Order (SWO): Maintain a valid order containing the patient's information, equipment description, order date, and treating practitioner's identification and signature.

Medical Necessity: The patient's medical record must support the need for the prescribed equipment under applicable coverage criteria.

Proof of Delivery: Maintain documentation confirming that the correct equipment was delivered to the beneficiary.

Equipment Condition: Retain appropriate supplier records establishing that the equipment was furnished as new.

Additional Requirements: Certain equipment requires prior authorization, a face-to-face encounter, or a written order before delivery.

Documentation Checklist:

Valid standard written order
Medical necessity supported
Correct HCPCS code selected
New equipment status verified
Proof of delivery retained
Additional coverage requirements satisfied

Important: Medicare suppliers generally must retain required DMEPOS documentation for seven years from the date of service.

Guidelines and Common Billing Mistakes

Accurate Modifier NU billing requires selecting the correct HCPCS code, confirming the equipment's purchase status, and following applicable payer policies.

Correct HCPCS Selection: Use the code that accurately describes the equipment furnished.

Modifier Compatibility: Confirm that NU is recognized for the specific equipment code and payment category.

Purchase vs. Rental: Use NU for an eligible new-equipment purchase, not for a rental billed with RR.

Additional Modifiers: Report other required modifiers when applicable. For example, some DME claims require coverage-related modifiers such as KX.

Common Billing Mistakes:

Incorrect Equipment Status: Reporting NU for previously used or rented equipment.
Missing Required Modifier: Omitting NU when the payer requires a new-equipment purchase designation.
Unsupported Purchase: Billing equipment as a purchase when the applicable Medicare payment category requires rental.
Incorrect Modifier Combination: Using incompatible modifiers or overlooking additional required modifiers.
Incomplete Documentation: Submitting claims without the required order, delivery evidence, or medical necessity support.

Important: Medicare DMEPOS payment rules vary by equipment category. Some items are eligible for purchase, while others are subject to rental arrangements.

Common Denial Reasons

Modifier NU claims may be denied when equipment eligibility, coverage requirements, or billing information do not meet payer guidelines.

Missing or Invalid Modifier: The claim lacks a required NU modifier or uses NU with an ineligible HCPCS code.

Medical Necessity Not Established: The patient's records do not support the equipment under the applicable coverage policy.

Incomplete Order or Delivery Records: Required documentation is missing, incomplete, or inconsistent with the billed item.

Incorrect Purchase Classification: Equipment is billed as a new purchase when the payer requires rental or another payment arrangement.

Duplicate or Replacement Claim: The payer identifies previously reimbursed equipment or an unsupported replacement request.

Prior Authorization Requirements: Required authorization or other pre-delivery conditions were not satisfied.

Important: Review the claim adjustment and remark codes, verify the applicable coverage policy, and correct or appeal the claim when supported by documentation.

Frequently Asked Questions

Can Modifier NU be used for replacement equipment?

Yes, when the replacement is a covered new-equipment purchase and the applicable HCPCS code and payer policy permit NU. However, replacement coverage may require additional documentation establishing why the existing equipment needs replacement.

Is Modifier NU required for every new DME purchase?

No. NU is required or recognized only for certain HCPCS codes and billing arrangements. Some equipment categories have different payment rules, so suppliers should verify the applicable Medicare DME MAC or commercial payer requirements before submitting the claim.